Provider Demographics
NPI:1447075015
Name:JESSTHERAPY PLLC
Entity type:Organization
Organization Name:JESSTHERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOMAR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-8911015
Authorized Official - Phone:208-627-7918
Mailing Address - Street 1:217 CEDAR ST # 302
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1410
Mailing Address - Country:US
Mailing Address - Phone:208-627-7918
Mailing Address - Fax:
Practice Address - Street 1:30410 HIGHWAY 200 STE 200B-3
Practice Address - Street 2:
Practice Address - City:PONDERAY
Practice Address - State:ID
Practice Address - Zip Code:83852-9601
Practice Address - Country:US
Practice Address - Phone:208-627-7918
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health